MEDICARE: LOPEZ MENTAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1295501278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOPEZ MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	12610 HENDERSON RD STE 4, STE 1003
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-6548
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12610 HENDERSON RD STE 4, STE 1003
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-6548
Country	:	US
Telephone Number	:	813-279-1364
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDGAR O LOPEZ DE CASTRO
Credential	:	MD
Telephone Number	:	813-279-1364

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	11/30/2023

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Directions to “LOPEZ MENTAL HEALTH LLC ” Practice Location

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